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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> 6'1306--1a5 <br /> �^ ;� ;� -49 <br /> -43 <br /> 3cx1 3 tA/. C 4si�✓� Roc.a 1JI(JS , �'�� - �� (A Oa <br /> PROJECT ADDRESS <br /> / �•rJue o�1J OCCVefreT 1A//f- gt.L03 <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> G go./ � KUO A/11/ Ott'l S J'. S C#(t S' 5—ctm(e / �t/if R fru 7 CioG)c(3 7-6(SO <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> E oyrtiE COI sc 4 icoo° <br /> State License Number Contract Price of Work <br /> p k e tae- , , (.-cG)11cr-cast <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Square Footage (If residential new construction, remodel or addition) <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: PfM C/0l P( �'STr ooh S <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 37D O <br /> I hereby certify that I have read and examined this application and know the same to be true and <br /> correct. All provisions of laws and ordinances governing this type of work will be completed <br /> whether specified herein or not. The granting of a permit does not presume to give authority to PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the (' , r <br /> performance of construction. That I am authorized by the owner of this property to perform the El( 2 J G l <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> CA C't <br /> Sign Date <br /> REVISED 3/20/13 <br />